Wiki CPT 81003 inclusvie denieal from Aetna.

[bsrinivasarao777]

Hi all,

Aetna insurance frequently denying CPT 81003 or 81002 charges as inclusive with E&M service (99201-99395).
Initially I tried with modifier “25” to E&M, after that I even tried with an appeal, but no use, it denied as inclusive again.

In this case I need clarification that, is there any payer policy in Aetna website regarding this.
Please help me with your opinions and provide me Aetna policies.

Thanks in Advance for your help.



Thanks & regards.
Srinivasarao.b

 

[CodingKing]

I wonder what changed. the last I have from 2016 states they updated the policy to allow w/ mod 25 on the E&M

https://www1.aetna.com/provider/medical/resource_med/communications_med/coding_change.html

Beginning with claims processed as of November 12, 2006, we will pay the following codes when billed with office-based evaluation and management codes (E&Ms) appended with Modifier 25:

1. urinalysis dipstick CPT codes: 81002 and 81003
2. pulse oximetry CPT codes: 94760, 94761, 94762

The office-based E&M codes that apply are 99201-99205, 99211-99215, 99241-99245 and 99381-99397.

 

[bsrinivasarao777]

Hi,
Thanks for spending time on my question. I even tried using this article, and added modifier "25"; but it got denied as inclusive, then finally i recommended with an appeal but i failed to get reimbursement. So please forward any payer policies or any updates.




Once again thanks for your help.


Regards,
Srinivasarao.b

 

[clstewart]

As long as you send the original claim with a 25 Modifier they will pay . They will not process a corrected claim for this after the original claim processes.

 

[millbj]

Does any Urology coders get the UA 81000, 81002, 81003 pd with an OV for a BCBS pt.

If so how are you billing the claim?

Thank you